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In the present study, we aimed to compare anthropometric indicators as predictors of mortality in a community-based setting.
We conducted a population-based longitudinal study nested in a cluster-randomized trial. We assessed weight, height and mid-upper arm circumference (MUAC) on children 12 months after the trial began and used the trial’s annual census and monitoring visits to assess mortality over 2 years.
Children aged 6–60 months during the study.
Of 1023 children included in the study at baseline, height-for-age Z-score, weight-for-age Z-score, weight-for-height Z-score and MUAC classified 777 (76·0 %), 630 (61·6 %), 131 (12·9 %) and eighty (7·8 %) children as moderately to severely malnourished, respectively. Over the 2-year study period, fifty-eight children (5·7 %) died. MUAC had the greatest AUC (0·68, 95 % CI 0·61, 0·75) and had the strongest association with mortality in this sample (hazard ratio = 2·21, 95 % CI 1·26, 3·89, P = 0·006).
MUAC appears to be a better predictor of mortality than other anthropometric indicators in this community-based, high-malnutrition setting in Niger.
The thymus undergoes a critical period of growth and development early in gestation and, by mid-gestation, immature thymocytes are subject to positive and negative selection. Exposure to undernutrition during these periods may permanently affect phenotype. We measured thymulin concentrations, as a proxy for thymic size and function, in children (n = 290; aged 9–13 years) born to participants in a cluster-randomized trial of maternal vitamin A or β-carotene supplementation in rural Nepal (1994–1997). The geometric mean (95% confidence interval) thymulin concentration was 1.37 ng/ml (1.27, 1.47). A multivariate model of early-life exposures revealed a positive association with gestational age at delivery (β = 0.02; P = 0.05) and higher concentrations among children born to β-carotene-supplemented mothers (β = 0.19; P < 0.05). At ∼9–12 years of age, thymulin was positively associated with all anthropometric measures, with height retained in our multivariate model (β = 0.02; P < 0.001). There was significant seasonal variation: concentrations tended to be lower pre-monsoon (β = −0.13; P = 0.15), during the monsoon (β = −0.22; P = 0.04), and pre-harvest (β = −0.34; P = 0.01), relative to the post-harvest season. All early-life associations, except supplementation, were mediated in part by nutritional status at follow-up. Our findings underscore the known sensitivity of the thymus to nutrition, including potentially lasting effects of early nutritional exposures. The relevance of these findings to later disease risk remains to be explored, particularly given the role of thymulin in the neuroendocrine regulation of inflammation.
Maternal systemic inflammation during pregnancy may restrict embryo−fetal growth, but the extent of this effect remains poorly established in undernourished populations. In a cohort of 653 maternal−newborn dyads participating in a multi-armed, micronutrient supplementation trial in southern Nepal, we investigated associations between maternal inflammation, assessed by serum α1-acid glycoprotein and C-reactive protein, in the first and third trimesters of pregnancy, and newborn weight, length and head and chest circumferences. Median (IQR) maternal concentrations in α1-acid glycoprotein and C-reactive protein in the first and third trimesters were 0.65 (0.53–0.76) and 0.40 (0.33–0.50) g/l, and 0.56 (0.25–1.54) and 1.07 (0.43–2.32) mg/l, respectively. α1-acid glycoprotein was inversely associated with birth size: weight, length, head circumference and chest circumference were lower by 116 g (P = 2.3 × 10−6), and 0.45 (P = 3.1 × 10−5), 0.18 (P = 0.0191) and 0.48 (P = 1.7 × 10−7) cm, respectively, per 50% increase in α1-acid glycoprotein averaged across both trimesters. Adjustment for maternal age, parity, gestational age, nutritional and socio-economic status and daily micronutrient supplementation failed to alter any association. Serum C-reactive protein concentration was largely unassociated with newborn size. In rural Nepal, birth size was inversely associated with low-grade, chronic inflammation during pregnancy as indicated by serum α1-acid glycoprotein.
Older adults, especially those above age 80, are the fastest growing segment of the population in the United States and at risk for age-related cognitive decline and dementia. There is growing evidence that cognitive activity and training may allow adults to maintain or improve cognitive functioning, but little is known about the potential benefit in the oldest old. In this randomized trial, the effectiveness of a computerized cognitive training program (CCT program) was compared to an active control games program to improve cognition in cognitively normal individuals aged 80 and older.
Sixty-nine older adults were randomized to a 24-session CCT program (n = 39) or an active control program (n = 30). Participants completed a pre- and post- training neuropsychological assessment. The primary outcome measure was a global cognitive composite, and the secondary outcomes were the scores on specific cognitive domains (of memory, executive function/attention, and language).
Using linear mixed models, there were no significant differences between the CCT and the active control program on the primary (p = 0.662) or any of the secondary outcomes (language functioning, p = .628; attention/executive functioning, p = .428; memory, p = .749).
This study suggests that short-term CCT had no specific benefit for cognitive functioning in non-demented individuals aged 80 and older.
The longevity of Cassini’s exploration of Saturn’s atmosphere (a third of a Saturnian year) means that we have been able to track the seasonal evolution of atmospheric temperatures, chemistry and cloud opacity over almost every season, from solstice to solstice and from perihelion to aphelion. Cassini has built upon the decades-long ground-based record to observe seasonal shifts in atmospheric temperature, finding a thermal response that lags behind the seasonal insolation with a lag time that increases with depth into the atmosphere, in agreement with radiative climate models. Seasonal hemispheric contrasts are perturbed at smaller scales by atmospheric circulation, such as belt/zone dynamics, the equatorial oscillations and the polar vortices. Temperature asymmetries are largest in the middle stratosphere and become insignificant near the radiative-convective boundary. Cassini has also measured southern-summertime asymmetries in atmospheric composition, including ammonia (the key species forming the topmost clouds), phosphine and para-hydrogen (both disequilibrium species) in the upper troposphere; and hydrocarbons deriving from the UV photolysis of methane in the stratosphere (principally ethane and acetylene). These chemical asymmetries are now altering in subtle ways due to (i) the changing chemical efficiencies with temperature and insolation and (ii) vertical motions associated with large-scale overturning in response to the seasonal temperature contrasts. Similarly, hemispheric contrasts in tropospheric aerosol opacity and coloration that were identified during the earliest phases of Cassini’s exploration have now reversed, suggesting an intricate link between the clouds and the temperatures. Finally, comparisons of observations between Voyager and Cassini (both observing in early northern spring, one Saturn year apart) show tantalizing suggestions of non-seasonal variability. Disentangling the competing effects of radiative balance, chemistry and dynamics in shaping the seasonal evolution of Saturn’s temperatures, clouds and composition remains the key challenge for the next generation of observations and numerical simulations.
The conservation benefits of maintaining social groupings during and after animal translocations are unclear. Although some studies report improved post-release survival, others found no discernible influence on reintroduction success. Understanding the effects of social groupings is difficult because release methods can influence the animals’ ability to maintain social groups. We explored this relationship by first studying whether release protocols influenced post-release cohesion in the communal burrowing bettong Bettongia lesueur, and then investigating whether maintenance of social cohesion conferred any post-release advantage. We released bettongs into a small (8 ha) and large (2,600 ha) area and compared the proportion that maintained social groupings in the different settings. The proportion of bettongs sharing with previous warren co-occupants was higher than expected by chance in both areas, however, a significantly higher proportion of bettongs maintained social groupings in the small (75%) compared to the large release area (13%). This suggests bettongs prefer to maintain social groupings but are unable to locate members of their group in large release areas. Bettongs that did maintain social groupings showed no difference in reproductive or health outcomes compared to those that formed new social groupings, suggesting no benefit to reintroduction success. We conclude that release protocols can influence post-release cohesion, but that greater cohesion does not necessarily confer advantages to group-living animals. To test the importance of social cohesion, further research on reintroductions should compare post-release parameters for animals released using protocols that do and do not facilitate maintenance of social groupings.
Environmental enteric dysfunction (EED) and systemic inflammation (SI) are common in developing countries and may cause stunting. In Bangladesh, >40 % of preschool children are stunted, but EED and SI contributions are unknown. We aimed to determine the impact of EED and SI (assessed with multiple indicators) on growth in children (n 539) enrolled in a community-based randomised food supplementation trial in rural Bangladesh. EED was defined with faecal myeloperoxidase, α-1 antitrypsin and neopterin and serum endotoxin core antibody and glucagon-like peptide-2, consolidated into gut inflammation (GI) and permeability (GP) scores, and urinary lactulose:mannitol α-1 acid glycoprotein (AGP) characterised SI. Biomarker associations with anthropometry (15-, 18- and 24-month length-for-age (LAZ), weight-for-length (WLZ) and weight-for-age (WAZ) z scores) were examined in pairwise correlations and adjusted mixed-effects regressions. Stunting, wasting and underweight prevalence at 18 months were 45, 15 and 37 %, respectively, with elevated EED and SI markers common. EED and SI were not associated with 15–24-month length trajectory. Elevated (worse) GI and GP scores predicted reduced 18–24-month WLZ change (β −0·01 (se 0·00) z score/month for both). Elevated GP was also associated with reduced 15–18-month WLZ change (β −0·03 (se 0·01) z score/month) and greater 15-month WLZ (β 0·16 (se 0·05)). Higher AGP was associated with reduced prior and increased subsequent WLZ change (β −0·04 (se 0·01) and β 0·02 (se 0·00) z score/month for 15–18 and 18–24 months). The hypothesised link from EED to stunting was not observed in this sample of Bangladeshi 18-month-olds, but the effects of EED on constrained weight gain may have consequences for later linear growth or for other health and development outcomes.
Russian-olive is a nitrogen-fixing tree invading riparian corridors in western North America. The premise of revegetation after weed removal is that revegetation is required to return native species to a removal site and that revegetation improves site resistance to invasion or reinvasion via competitive exclusion. Therefore, we expected that revegetation would reduce invasive species cover and increase native species cover compared with non-revegetated controls. Native understory species diversity increased with time since removal. We recorded 18.2 native species in 2012, and 28.2 native species in 2016. Out of 22 planted species, 2 did not establish. Diversity in revegetated plots did not differ from unplanted controls, likely because species spread quickly across plot boundaries. Native perennial grass, seeded species, and annual bromes increased over time, while nonnative forbs and native forbs decreased over time. Only invasive perennial grass cover responded to the revegetation treatment with cover much higher in controls compared with revegetated plots (25.7% vs. 7.7%); this was likely a response to a preplanting herbicide treatment. All categories of species diversity except invasive species diversity increased over time. Only 4% of Russian-olive stumps resprouted in the first year of removal, less than 1% resprouted 2 yr after removal. There was no Russian-olive emergence from seed in the removal year, and seed emergence varied exponentially among following years. Seeded native species did not have trouble establishing once adequate spring moisture occurred in the second growing season after Russian-olive removal, indicating that removal did not present substantial obstacles to successful revegetation. Follow-up control of Russian-olive is critical after initial treatment.
Kentucky bluegrass (Poa pratensis L.) invades northern Great Plains rangelands. On the Sheyenne National Grassland in southeastern North Dakota, three research sites, each with a different level of Kentucky bluegrass invasion, were chosen to evaluate effectiveness of burning and burning–herbicide combinations to control Kentucky bluegrass. Initial Kentucky bluegrass invasion levels were 37%, 77%, and 91% for LOW, MODERATE, and HIGH invaded sites, respectively. Within each invaded site, four replicated strips (20 by 60 m) were established, with half of each strip burned in late October 2005 and the other half burned in early May 2006. Herbicide treatments of (1) no herbicide, (2) 2.24 kg ha−1 of glyphosate, and (3) 0.43 kg ha−1 of imazapic were randomly assigned to 10 by 20 m subplots within each burn. Control plots were established at the same time. Relative basal cover of native grass, native forb, and Kentucky bluegrass was estimated annually using 50 10-point frames within each subplot. On the HIGH site in 2006, fall-burned plots with a spring glyphosate application had three times the native grass cover and only one fourth of the Kentucky bluegrass cover compared with controls. Similar results with the same treatment occurred at the MODERATE site. Native grasses became the most abundant plant community on these plots in the MODERATE and HIGH sites within 1 yr. Treatment differences were transitory, and the LOW site differed from the MODERATE and HIGH sites. In 2007, on fall-burned plots with spring glyphosate application, the amount of Kentucky bluegrass was 14% and 30%, and native grass species were 52% and 42% on the MODERATE and HIGH sites, respectively, which was similar to the initial values on the LOW site. These data emphasize the importance of initial invasion level in developing restoration strategies and provide evidence burning and herbicide combinations can be valuable management tools even on heavily invaded grasslands.
Whole apples have not been previously implicated in outbreaks of foodborne bacterial illness. We investigated a nationwide listeriosis outbreak associated with caramel apples. We defined an outbreak-associated case as an infection with one or both of two outbreak strains of Listeria monocytogenes highly related by whole-genome multilocus sequence typing (wgMLST) from 1 October 2014 to 1 February 2015. Single-interviewer open-ended interviews identified the source. Outbreak-associated cases were compared with non-outbreak-associated cases and traceback and environmental investigations were performed. We identified 35 outbreak-associated cases in 12 states; 34 (97%) were hospitalized and seven (20%) died. Outbreak-associated ill persons were more likely to have eaten commercially produced, prepackaged caramel apples (odds ratio 326·7, 95% confidence interval 32·2–3314). Environmental samples from the grower's packing facility and distribution-chain whole apples yielded isolates highly related to outbreak isolates by wgMLST. This outbreak highlights the importance of minimizing produce contamination with L. monocytogenes. Investigators should perform single-interviewer open-ended interviews when a food is not readily identified.
Long-term care facilities (LTCFs) and their residents are especially susceptible to disruptions associated with natural disasters and often have limited experience and resources for disaster planning and response. Previous reports have offered disaster planning and response recommendations. We could not find a comprehensive review of studied interventions or facility attributes that affect disaster outcomes in LTCFs and their residents. We reviewed articles published from 1974 through September 30, 2015, that studied disaster characteristics, facility characteristics, patient characteristics, or an intervention that affected outcomes for LTCFs experiencing or preparing for a disaster. Twenty-one articles were included in the review. All of the articles fell into 1 of the following categories: facility or disaster characteristics that predicted preparedness or response, interventions to improve preparedness, and health effects of disaster response, most often related to facility evacuation. All of the articles described observational studies that were heterogeneous in design and metrics. We believe that the evidence-based literature supports 6 specific recommendations for facilities, governmental agencies, health care communities and academia. These include integrated and coordinated disaster planning, staff training, careful consideration before governments order mandatory evacuations, anticipation of the increased medical needs of LTCF residents following a disaster, and the need for more outcomes research. (Disaster Med Public Health Preparedness. 2017;11:140–149)
Reintroduction practitioners must often make critical decisions about reintroduction protocols despite having little understanding of the reintroduction biology of the focal species. To enhance the available knowledge on the reintroduction biology of the warru, or black-footed rock-wallaby Petrogale lateralis MacDonnell Ranges race, we conducted a trial reintroduction of 16 captive individuals into a fenced predator and competitor exclosure on the An̲angu Pitjantjatjara Yankunytjatjara Lands in South Australia. We conducted seven trapping sessions and used radio-tracking and camera traps to monitor survival, reproduction and recruitment to the population over 36 months. Blood samples were collected pre-release and during two trapping sessions post-release to assess nutritional health. The survival rate of founders was 63%, with all losses occurring within 10 weeks of release. Post-release blood biochemistry indicated that surviving warru adapted to their new environment and food sources. Female warru conceived within 6 months of release; 28 births were recorded during the study period and 52% of births successfully recruited to the population. Our results suggest that captive-bred warru are capable of establishing and persisting in the absence of introduced predators. However, the high mortality rate immediately post-release, with only a modest recruitment rate, suggests that future releases into areas where predators and competitors are present should use a trial approach to determine the viability of reintroduction. We recommend that future releases of warru into unfenced areas include an intensive monitoring period in the first 3 months post-release followed by a comprehensive long-term monitoring schedule to facilitate effective adaptive management.
This paper discusses three cases of tracheal agenesis that presented within a six-week period to the Norfolk and Norwich University Hospital. By reviewing the available literature on tracheal agenesis, the report aims to outline a protocol for future prenatal and postnatal management.
A case series and a literature review.
Three cases of tracheal agenesis presented in the classical manner, with respiratory distress and unsuccessful intubation following delivery. A literature review confirmed that prenatal diagnosis requires future innovation; survival is rare and is predominately reliant on intubation of the oesophagus when a patent tracheoesophageal fistula is present. In most cases, tracheal agenesis represents part of the ‘VATER’ association: vertebral defects, anal atresia, tracheoesophageal fistula with oesophageal atresia, and radial or renal dysplasia. Complex, multiple-stage surgical procedures have been described; however, no survival to adolescence is documented.
There is a call for improved prenatal diagnosis to allow both adequate counselling of parents and preparation for multi-specialty management at delivery. In addition, these cases highlight the ongoing need for improved congenital anomaly data within the UK, with currently only 49 per cent of England's births being registered.
Field stars provide important constraints for the late stages of stars' angular momentum evolution. We measured rotation periods ranging from 0.1 to 150 days for approximately 450 mid-to-late M dwarfs using photometry from the MEarth transiting planet survey. We use parallaxes, proper motions, and radial velocities to calculate galactic kinematics for these solar neighborhood M dwarfs. The velocity dispersions increase towards longer rotation periods, indicating that there is a relationship between rotation and age for these stars.
Background: Gamma Knife (GK) radiosurgery for pediatric arteriovenous malformations (AVM) of the brain presents a non-invasive treatment option. We report our institutional experience with GK for pediatric AVMs. Methods: We performed a retrospective review of all pediatric patients treated with GK for cerebral AVMs at our institution from November 2003 up to and including September 2014. Patient demographics, AVM characteristics, treatment parameters and AVM responses were recorded.Results: Nineteen patients were treated, with 4 lost to follow-up. The mean age was 14.2 years (range. 7-18 years), with 10 being males (52.6%). The mean AVM diameter and volume were 2.68 cm and 3.10 cm3 respectively. The mean Spetzler-Martin (SM) and Pollock grades of the treated AVMs were 2.4 and 0.99 respectively. The mean follow-up was 62 months. All AVMs treated demonstrated a response on follow-up imaging. Nine of 15 (60.0%) patients displayed obliteration of their AVMs. Nine of 11 patients with a minimum of 3 years follow-up (81.8%) displayed obliteration, with SM and Pollock grades correlating to the chance of obliteration in this group. Two patients developed post-GK edema requiring short course dexamethasone therapy. No other major complications occurred. No permanent complications occurred.Conclusions: GK radiosurgery for pediatric AVMs offers a safe and effective treatment option, with low permanent complication rates during early follow-up.
Innate-like B1a lymphocytes arise from long-lived progenitors produced exclusively by fetal stem cells. Any insults coinciding with this early lymphopoietic wave could have a permanent impact on the B1a population and its unique protein products, the natural antibodies (NAb). We investigated early life nutritional influences on NAb concentrations of pre-adolescent children (n=290) in rural Nepal for whom we had extensive information on exposures from pregnancy and early infancy. Infant size and growth were strongly associated with NAb concentrations at 9–13 years of age among males (e.g., for neonatal weight: βBOYS=0.43; P<0.001), but not females (e.g., for neonatal weight: βGIRLS=−0.16; P=0.26). In females, season of birth was associated with NAb concentrations, with marked reductions among girls born during the pre-monsoon (March–May; βGIRLS=−0.39; P=0.01) and pre-harvest (September–November; βGIRLS=−0.35; P=0.03) seasons. Our findings suggest that nutritional or other environmental influences on immune development may vary by sex, with potential consequences for immune function during infancy and long-term risk of immune-mediated disease.
We aimed to compare access to gynecologic oncology care at a private and a city hospital, both of which closed for a period of time because of Hurricane Sandy.
This was a cross-sectional study of gynecologic oncology chemotherapy, radiotherapy, and surgical patients from October 29, 2012 (the eve of the storm), to February 7, 2013 (the reopening of the city hospital). New referrals during this time were excluded. Delays in chemotherapy, radiotherapy, and surgery were compared.
Analysis included 113 patients: 59 private patients (52.2%) and 54 city patients (47.8%). Of the private patients, 33/59 received chemotherapy (55.9%), 1/59 received radiotherapy (1.7%), and 28/59 had planned surgery (47.5%). Of the city patients, 40/54 received chemotherapy (74.1%), 7/54 received radiotherapy (12.3%), and 18/54 had planned surgery (33.3%). The mean delay in chemotherapy was 7.6 days at the private hospital and 21.7 days at the city hospital (P=0.0004). The mean delay in scheduled surgery was 14.2 days at the private hospital and 22.7 days at the city hospital (P=0.3979). The mean delay in radiotherapy was 0.0 days at the private hospital and 25.0 days at the city hospital (P=0.0046). Loss to follow-up rates were 3/59 of the private patients (5.1%) and 3/54 of the city patients (5.6%).
Gynecologic oncology care was maintained during a natural disaster despite temporary closure and relocation of services. Disparity in care was in access to chemotherapy. (Disaster Med Public Health Preparedness. 2015;9:605–608)
Catalytic chemical vapor deposition (CVD) is a popular method to synthesize carbon nanotubes (CNTs). At the presence of catalysts (usually trasition metals), the hydrocarbon feedstock decomposes controllably at elevated temperatures and can form tubular structures. It has been suggested that trace amounts of weak gas-phase oxidants, such as CO2, can enhance the CNT synthesis by extending the catatlyst life. It is not clear, however, how such additives affect the CVD reaction environment. In this study, ethylene gas was introduced to a preheated furnace/CVD reactor where meshes of stainless steel were placed. Therein ethylene was thermally decomposed in nitrogen mixed with different amounts of carbon dioxide. The meshes served as catalytic substrates for the CNT growth. The compositions of the ethylene pyrolyzates were analysed both with and without the presence of catalysts, to explore the possible contributions of CO2 addition to the CNT formation. The latter compositions were compared with kinetic model predictions of the thermal decomposition of ethylene. Both experimental and simulation results indicated that 1,3-butadiene (C4H6) was the most abundant hydrocarbon species of ethylene decomposition (at 800 °C) and that decomposition was inhibitted at the presence of CO2. A commesurate effect on CNT formation was observed experimentally, whereas the quality of CNTs got improved.